Maternal near miss at Kathmandu Medical College: An analysis of severe maternal morbidity at a Nepalese tertiary care facility.

BACKGROUND: The World Health Organization (WHO) 'near miss' tool has been extensively used to audit maternal morbidity in low- and middle-income countries. Analysis of the cases of 'near miss' enables a better understanding of the associated factors, identifies deficiencies in the provision of maternity services and lays a foundation for better preventive measures in the future. AIMS: To understand the epidemiology, aetiology and determine the aspects of preventability of maternal 'near miss' (MNM) at Kathmandu Medical College. MATERIALS AND METHODS: A prospective audit of MNM and maternal deaths (MD) was undertaken at Kathmandu Medical College over a period of 12 months. The cases were identified using WHO 'near miss' criteria and areas of preventability in the provision of care determined using the modified Geller's criteria. RESULTS: The total number of deliveries and live births in the study period were 2747 and 2698 respectively. A total of 34 'near misses' and two MDs were identified. The common direct aetiologies of MNM and MDs identified were obstetric haemorrhage followed by hypertensive disorders with one-third of cases being of indirect aetiology. Fifty-five percent of cases had some aspects of provider- or system-related preventability with the leading delays being lack of diagnosis and recognition of high-risk status among patients and lack of interdepartmental communication. CONCLUSION: The WHO near miss rate at Kathmandu Medical College was 12.5/100 live births. Significant aspects of preventability, especially at the level of the provider, were noted among cases of MNM and MDs.

Lifestyle Behaviours among General Population During Lockdown Period during Corona Virus Disease-19 Pandemic.

BACKGROUND: Healthy lifestyle behaviours have been consistently associated with reduced non-communicable disease related morbidity, mortality and wellbeing. Unhealthy behaviours are major contributors to the global burden of disease. The main aim of this study is to access lifestyle behaviours in adults during the corona virus disease-19 pandemic. METHODS: Cross sectional study was conducted among general population residing in Nepal. Online questionnaire was developed using Google Forms. Questionnaire comprised of three validated tools regarding the following lifestyle behaviours: Physical activity, Nutrition, Sleep. The collected data was analysed using SPSS version 20. To test the differences between changes in dietary and physical activity behaviours in relation to changes in body weight a Chi-square test was used. RESULTS: During Covid -19 lockdown, 124(42%) participants performed moderate level of physical activity. Of those participated, 127(43.1%) and 44(14.9%) reported an increase and decrease of weight, respectively. Among 110(37.3%) who reported snacking in lockdown led to weight gain in 68(61.8%). Availability of more time for meal preparation (24.1%) and feelings of boredom (17.4%) were the main reasons for changing dietary habits. The subjective sleep quality of participants was as follows: very good-40.3%; fairly good-45.4 %; fairly bad-11.2%; very bad 3.1%. There was significant positive correlation between sleep quality and sleep duration (R=0.261; P<0.001), sleep latency (R=0.362; P<0.001), sleeping medications (R=0.174; P<0.003) and daytime dysfunction (R=0.308; P<0.001). CONCLUSIONS: Life style behaviours were affected during lockdown period. Higher amounts of food intake and snaking were increased. Physical activity was at a moderate level, increased sedentary behaviour was reported by most participants during lockdown. However, sleep quality was not negatively affected.

Severe Stress among Medical Students of Two Medical Colleges: A Descriptive Cross-sectional Study.

Introduction: Mental health problems are common in medical students and there is a high prevalence of psychological morbidity among them. The inability to use effective coping strategies affects the health and academic performance of students. The aim of this study was to find out the prevalence of severe stress among medical students of two medical colleges. Methods: A descriptive cross-sectional study was conducted among medical undergraduates of two medical colleges from 14 September to 14 October 2021. Ethical approval was taken from the Institutional Review Committee (Reference number: 0609202109). Three hundred fifteen students were selected for the study using the proportionate stratified random sampling technique. Perceived Stress Scale was used to assess the level of stress and the Brief Cope Inventory scale was used to assess the coping strategies employed by students during stress. Point estimate and 95% confidence interval was calculated. Results: Among 315 medical students, severe stress was found in 39 (12.38%) (8.76-16.04, 95% Confidence Interval). Conclusions: The prevalence of severe stress among medical students was higher when compared to similar studies done in similar settings. Keywords: coping strategies; medical students; psychological stress.

Knowledge of Vitamin D among First-year Medical Undergraduate Students of a Medical College: A Descriptive Cross-sectional Study.

INTRODUCTION: Vitamin D also known as the sunshine vitamin, helps in bone metabolism and calcium homeostasis. It is estimated that one billion people in the world have vitamin D deficiency making it a public health problem. The objective of this study is to find out the knowledge regarding vitamin D among first-year medical undergraduate students of a medical college. METHODS: This is a descriptive cross-sectional study carried out from 2nd February 2020 to 15th February 2020 at Kathmandu Medical College Teaching Hospital, Duwakot among medical undergraduate students of a medical college. Ethical clearance was received from the Institutional Review Committee of Kathmandu Medical College Teaching Hospital (Reference Number: 2812201809). A structured self-designed multiple-choice questionnaire on vitamin D knowledge was used. Convenient sampling method was applied and statistical analysis was done with Statistical Package for the Social Sciences 20 version. RESULTS: Out of total 157 undergraduate medical students, 21 (13.3%) exhibited good knowledge, 116 (73.9.8%) had average, and 20 (12.8%) had poor knowledge. There were 83 (52.9%) Bachelor of Medicine and Bachelor of Surgery students, 39 (24.8%) were Bachelor of Dental Surgery and 35 (22.3%) were Nursing students. CONCLUSIONS: We found a satisfactory level of knowledge of vitamin D among first-year undergraduate medical students of a medical college when compared to similar studies. The majority of students from all three disciplines had average knowledge of vitamin D.

Anxiety among Pregnant Women about Corona Virus Infections during COVID-19 Pandemic at a Tertiary Care Center in Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: COVID-19 is a beta coronavirus that is transmitted by physical interaction or close contact. This Coronavirus Pandemic has also created stress and anxiety among pregnant women all over the world. The disease was first identified in Wuhan city, China, in late December 2019 and was declared pandemic by the World Health Organization on 11th March 2020. Concern and stress in pregnancy are associated with pre-eclampsia, intrauterine growth restriction, preterm labour, depression etc. Pregnancy is an immune-compromised state and poses a high risk to this risk. This study aims to identify anxiety about the coronavirus infection among pregnant women visiting a tertiary care centre in Kathmandu, Nepal, during this COVID-19 pandemic. METHODS: This is a descriptive cross-sectional study conducted at Kathmandu Medical College and Teaching Hospital from 15th July 2020 to 30th July 2020 after taking the ethical clearance from the Institutional Review Committee of Kathmandu Medical College (reference no. 207202002). Convenient sampling method was used. All the data were entered in Statistical Package for the Social Sciences data 20.0 and analyzed. Data was presented in frequencies, charts and percentage. RESULTS: Among the total 273 cases, only 2 (0.73%) cases had a score between 25-30 corresponding to moderate to severe anxiety, 21 (7.69%) had a score between 18-24, which corresponds to mild to moderate anxiety and 250 (91.57%) had score 0-17 which corresponds mild status. CONCLUSIONS: Most of the participants in the study reported a mild status of anxiety. Very few participants reported moderate to severe anxiety.

Knowledge of Physiotherapy Practice among Medical Interns in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Medical doctors have profound influence on other health professions including physiotherapist as they are at the top of the pyramid of healthcare profession. There is a lack of knowledge of physiotherapy among medical doctors. They may not be knowing of all physiotherapy services and practice. The objective of this study was to find adequate knowledge of physiotherapy practice among medical interns in a tertiary care hospital. METHODS: A descriptive cross-sectional study was conducted on medical interns of a tertiary hospital of Kathmandu between 21st March - 20th May 2021, after taking ethical approval from the Institutional Review Committee. A convenient sampling method was used and sample size was calculated to be 94. A structured questionnaire was used to collect the demographic details and knowledge of Physiotherapy. Data was analyzed using statistical package for the social sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. RESULTS: The knowledge of physiotherapy practice was seen adequate among 16 (17%) (95% Confidence Interval = 9.41-24.59) medical interns. Physiotherapy is effective in reducing pain was acknowledged by 89 (97.4 %), 61 (64.9 %) had knowledge about conditions treated by physiotherapy, 55 (58.5 %) had knowledge that physiotherapy treatment follows definite treatment protocol and 26 (27.7 %) had knowledge that exercise prescription is done in physiotherapy. CONCLUSIONS: The prevalence of adequate knowledge is less in our study which is similar to other studies done in similar settings. Therefore, there is a need of educating the future medical doctors about physiotherapy, thereby reaching a better patient care.

Awareness on Social Health Insurance Scheme among Locals in Bhaktapur Municipality.

BACKGROUND: Illnesses impose a huge economic burden on individuals and families. Costly health care also discourages people from using health services thereby generating prolonged or worsened health problems. The recently endorsed National Health Insurance Policy forecasts the integration of all social health protection schemes thereby ultimately achieving universal coverage. The aim of this study was to find out the awareness of health insurance and evaluate source of information about health insurance. METHODS: A cross sectional study was conducted on 385 participants from 5 randomly selected wards of Bhaktapur Municipality on July 2019. Households with health insurance were selected. The interview was taken either from the head of the family or the family member who takes financial decisions in the house. Face to face interview was taken in local language (Newari). Good and poor categories on awareness were developed. Descriptive statistics was applied. RESULTS: Good awareness of social health Insurance scheme was found among 335(87.2%) participants. 99% of the participants showed the importance of social health insurance. The main source of information was insurance agents (47.3%) and female community health volunteers (28.6%). Regarding benefits of opting health insurance, 66.5 % of the participants stated that it would reduce out-of-pocket expenditure. 65.5% opined that it would help in case of emergency medical situations. About 91.9% of respondents wanted to renew their health insurance in future also. CONCLUSIONS: Awareness regarding health insurance was found good, which shows the positive acceptance of social health Insurance scheme by community. Insurance agent and hemale community health volunteers (FCHV) seemed to have played an important role in dissemination of information.

Morbidity of School Children in Panauti Municipality of Kavrepalanchowk: A Descriptive Cross-sectional Study.

INTRODUCTION: School health has been considered as a high priority intervention in developing countries but it has not been prioritized in Nepal. The objectives of the study are to find out the prevalence of morbidity and nutritional status in school children. METHODS: A descriptive cross-sectional study was conducted in a private school located at Panauti Municipality of Kavrepalanchowk district for one week of November 2019. A convenient sampling technique was used. From a selected school, a total number of 356 students studying from Grade I to X were included in the study using. Confidence Interval at 95% was calculated along with frequency and proportion for binary data using Statistical Package for Social Science (SPSS) software. RESULTS: Among 356 students, the most common three morbidities were dental caries 43 (18.1%), tonsillitis 26 (6.2 %), and headache 18 (7.1 %). Based on weight for age, 43 (23.9%) boys and 22 (12.5%)girls were underweight and 12 (6.7%) boys and 4 (2.7%) girls were overweight and 6 (2%) were obese. Thus school health programs should give more emphasis on oral health, nutrition, personal hygiene, etc. CONCLUSIONS: The health and nutritional status of school children in this study were found to be satisfactory compared to other studies. The present study emphasized oral health. The school health program is important in the school for the prevention of diseases like a parasitic infestation, improving personal hygiene, and nutritional status.

Health Co-morbidities and Early Marriage in Women of a Rural Area of Nepal: A Descriptive Cross-Sectional Study.

INTRODUCTION: Early marriage is defined as the marriage of a young person less than 18 years. Early marriage is more prevalent in South Asia as more than half of all child marriage occurs here. Thirtyseven percent of girls in Nepal marry before age 18 years. This study was done to find out the health consequences of early marriage in women of a rural area of Nepal. METHODS: A descriptive cross-sectional study was conducted from 10th to 15th Feb 2020 February in 358 women from Panauti, Kavrepalchowk. The convenient sampling method was used. Ethical approval was taken from the Institutional Review Committee. Economic status was assessed by using Kuppuswamy’s socioeconomic scale. The collected data were analyzed using the Statistical Package for Social Science version 20. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. RESULTS: The prevalence of early marriage was 187 (52.2%) (47.03 to 57.37 at 95% confidence interval). One hundred sixteen (62%) early marriage women had gynecological problems followed by depression problem 85 (45.5%) and miscarriage 32 (17.1%). The mean age of marriage was 17.2 years. The majority, i.e. 167 (89.3%) of respondents who married earlier were Hindu by religion. Early marriage was observed in 104 (55.6 %) of illiterate women. CONCLUSIONS: The prevalence of early marriage was high. Early married women had a lower level of socio-economic status, lower level of education, which harmed the participants' health status.

Knowledge, Attitude and Practice about Vitamin D among Pregnant Women at a Municipality of Bhaktapur.

INTRODUCTION: Almost a billion people in the world are affected by Vitamin D deficiency. During pregnancy, the deficiency of Vitamin D can manifest as gestational diabetes, pre-eclampsia, preterm birth, or miscarriage in the early stages of pregnancy. The objective of this study was to assess the knowledge, attitude, and practice, and importance of Vitamin D among pregnant women via a focus group. METHODS: A qualitative study was carried out at Changu Narayan Municipality, Duwakot ward no. two, Bhaktapur district from November to December 2019 after approval from the Institutional Review Committee of Kathmandu Medical College (Ref. 181020192). Participants were selected via the Female Community Health Volunteer's pregnant women list by purposive sampling method. Focus group discussion was conducted among pregnant women. The interview questions were open-ended and the data were analyzed using thematic analysis. RESULTS: Study participants showed limited knowledge on vitamin D. Few participants had information regarding sun exposure for vitamin D. But many participants had negative attitudes towards sun exposure and lack of knowledge on sun exposure requirements. The participants have a huge knowledge gap between Vitamin D and its importance in pregnancy. CONCLUSIONS: Increasing awareness of the importance of Vitamin D among pregnant women is required.

Household Expenditure on Diarrhea Treatment among Under Five Children in Godawari Municipality of Nepal.

BACKGROUND: Diarrheal disease is a global public health problem. In Nepal, diarrhea is still the leading cause of waterborne disease, which constitutes 48% among all hospitalized disease cases who come to health center for treatment. Despite low treatment cost of diarrhea, out-of-pocket expenditure required at the time of treatment is a major barrier to seek health care. This study, therefore, aims to explore household expenditure for the diarrheal treatment in under five children and its financial burden in households. METHODS: A community based cross sectional study was carried out in 14 wards of Godawari Municipality among under five children with diarrhea from June 2018 to September 2018. We conducted financial burden survey among 371 household with diarrhea cases. RESULTS: Prevalence rate of diarrhea was found 50% among under five children. The average out-of-pocket expenditure was NRs 568.62 (US $5.06) per episode for diarrhea treatment. The total average direct cost for diarrheal treatment was NRs 183.58 (US $1.63). The two major cost driver during each episode were loss of wage by parents NRs 360.97 (US $3.21) and medicine costs NRs 114.15 (US $1.01). CONCLUSIONS: The Diarrheal prevalence rate in the study area was found higher than the National. The indirect cost of each diarrheal episode is more than three times of the direct cost.

Morbidity Pattern among Elderly Population of Changu Narayan Municipality, Bhaktapur.

BACKGROUND: The Senior Citizens Acts 2063, Nepal defines the senior citizens (elderly population) as "people who are 60 years and above". Health is the most important determinant of the quality of life of people. Ill-health becomes a major obstacle for the well-being of the elderly population. This study was conducted to assess the morbidity pattern in elderly population. METHODS: A community based cross-sectional study was carried out in field practice area of the Department of Community Medicine. 124 elderly population were selected by convenient sampling technique. A structured questionnaire was used to collect the data. Data was analyzed using SPSS version 20. Chi-square was used to test the association and p<0.05 was considered as significant. RESULTS: The mean age of elderly population was 69.85 years. Majority (47.6%) of them were in the age group of 60-69 years. Males (50.8%) were more than females (49.2%). Twelve respondents (9.7%) were not suffering from any form of morbidity. Most common morbidity was muscular skeleton problem (40.8%), followed by hypertension (36.3%), diabetes (29.8.8%), psychological (23.4%) and respiratory (18.6%). Other morbidities gastrointestinal, dental, ENT, eye and genitourinary system were found in around ten percentage of elderly population Conclusions: Majority of the elderly population were suffering from non-communicable diseases. There is a need for health care services at all level with special focus on disease prevention, early detection and treatment for elderly population. This study found high prevalence of musculoskeletal, hypertension, diabetes and psychological problem and low prevalence of respiratory, gastrointestinal, dental, ENT, genitourinary and eye problem.

Quality of Life of Peri and Postmenopausal Women attending Outpatient Department of Obstretics and Gynecology of A Tertiary Care Hospital.

BACKGROUND: Many women experience menopausal symptoms during menopausal transition and postmenopausal years. This natural phenomenon often results in various psychological, somatic and urinary symptoms which impair the overall quality of life of women. This study aimed to access the quality of life of women during perimenopausal and early postmenopausal years attending outpatient department of OBGYN at Kathmandu Medical College Teaching Hospital. METHODS: A descriptive cross-sectional study of 240 perimenopausal women of aged 45-60 years attending gynaecological outpatient clinic was carried out between 15th January to 13th April 2017. Data were collected using Women Health Questionnaire, containing 37 questions by interview technique and analyzed using chi-square test to assess the association between sociodemographic information and the quality of life. RESULTS: The median age of onset of menopause was 50 years and 50.8% of respondents were having good quality of life. Sociodemographic variables such as age of women, marital status, educational level, last menstrual period and regular menstrual period were statistically significant with the quality of life of peri and postmenopausal women. CONCLUSIONS: Menopausal symptoms are common but due to lack of awareness, they do not seek medical advice. Hence priority lies on generating awareness among women about menopause and menopausal symptoms and establishment of dedicated elderly clinic to help these women live a healthy and comfortable life.

Prevalence of Alcohol Consumption and Knowledge About Alcohol at Bhimtar, Sindhupalchowk.

INTRODUCTION: Alcohol causes several health problems, economic and social consequences across the world. Nepal is a multicultural and multi-ethnic country with an ambivalent regarding alcohol use according to social, religious and cultural values. Alcohol use is very common and easily available everywhere in Nepal. Objective of study is to find the prevalence of alcohol consumption and knowledge of alcohol among people at Bhimtar. METHODS: A cross sectional study was conducted on a total of 369 households, age above 20 years of Bhimtar, Sindhupalchowk district on November 2016. Total 41 households were selected using cluster sampling from all nine wards of Bhimtar village development committee. RESULTS: The prevalence of alcohol consumption was 232 (62.9%) in which 144 (77.4%) of males and 88 (48.1%) of females. There was 3.3 times more chance of consuming alcohol in male than female. Majority 137 (37%) consumed Raksi followed by Jaand/Chhyang 115 (31.3% ) and mix 97 (26.4%). On knowledge of alcohol consumption, 280 (75.9 %) and 288 (78.0%) of current drinker opined that it would effects own health and on the family respectively. After drinking alcohol 118 (31.9%) felt it relieved tiredness followed by felt better 103 (28%) and reduced stress 70 (18.9%). It affects heart and damage liver said by 72 (19.4%) and 59 (16%) respectively. There were family conflict after drinking alcohol replied by 132 (35.8%). They have good knowledge about the affect of alcohol on pregnant women. Only 50 (13.5%) of respondent expressed that it can be given to pregnant women. CONCLUSIONS: The prevalence of alcohol consumption was very high. There is markedly differed in alcohol consumption by sex. It is affecting their health and family. Consumption of alcohol is financial burden and makes conflict in the family, which will also make psychological affect on their children. There is significant difference in knowledge of harm on alcohol consumption by education status. It is essential to plan and develop a specific health education program among these at-risk populations for prevention of alcohol consumption.